Evidence-based programs to improve outcomes for high-risk families in NSW

May 2021

An evaluation was recently conducted on the adaptation, implementation and outcomes of two family preservation and restoration programs: Functional Family Therapy – Child Welfare (FFT-CW®) and Multisystemic Therapy for Child Abuse and Neglect (MST-CAN®) in the NSW context. The innovation of these programs lies in moving from an over-reliance on out of home care placements as a strategy to protect vulnerable children to providing intensive, structured therapy aimed at keeping vulnerable families together. Their over-arching objective is to simultaneously reduce the incidence of child abuse and neglect and the number of children who enter out of home care. During this initial testing phase, FFT-CW® is being delivered by nine Services Providers in 11 regional and metropolitan locations across NSW, and MST-CAN® is being delivered by six Services Providers in six regional and metropolitan locations. This evaluation covers the period from the first intake of families into these programs (1 August 2017) to 31 December 2019. It comprises a process evaluation, an outcome evaluation and an economic evaluation.

The process evaluation shows 2,511 families were referred to a program in this period (87% of the anticipated number), of which 29% were Aboriginal families. The delivery of the programs is being closely monitored, and they are largely being delivered as planned. Semi-structured interviews with families that completed a program (n=8) and senior staff managing the programs (n=8) identified strong consensus on two key enabling themes: i) the therapeutic and outcome-focused nature of the programs; and ii) the flexibility with which the programs are able to be delivered to optimise the engagement and retention of families.

The outcome evaluation focused on the families that were referred to a program between 1 August 2017 and 31 December 2018 and met all the eligibility criteria (n=316), and completed their involvement in a program by 31 December 2018 (n=155).

The end date of December 2018 allowed the primary outcome (out of home care entry within 12 months of a Child Protection Helpline contact) to be examined over a 12-month observation window to December 2019. Although the outcome needs to be interpreted cautiously because the early stage of this evaluation means the number of families who completed their program by 31 December 2018 is relatively small, the trends are generally positive: children or young people whose family did not complete a program have up to 14.3 times the odds of entering OOHC within 12 months of their Child Protection Helpline contact relative to children or young people whose family completed the high track version of FFT-CW® (n=120 families) and 3.5 times the odds of entering OOHC relative to children or young people whose family completed the low track version of FFT-CW® (n=23 families), but there is no difference as yet relative to those whose family completed MST-CAN® (n=12 families). There was also an analysis of those who completed their involvement in the program by 30 June 2019 with a follow-up period of 6-months, allowing for analysis of a larger number of families, results of which are included in Appendix 6.5. The economic evaluation is currently showing that the benefit-cost ratio for each program is less than 1, meaning that the monetarised benefit for families that complete their program is currently less than their costs.

This research was commissioned under the Their Futures Matter (TFM) reform, which now sits under the Stronger Communities Investment Unit (SCIU). UNSW Sydney’s National Drug and Alcohol Research Centre (NDARC) was selected to independently evaluate these programs. This is the final evaluation in a schedule of three.

Watch George present a NDARC webinar on this topic here